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WATER/SEWER UTILIT'Y !�ERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98207 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.gov <br />r r3 �2 ����'clLe� �-�, ��� U� �� zo I <br />PROJECT ADDRESS <br />soe d-S� a✓n4 z(c� I�JZ_ Ya ��i fh�{ �tIF�L�'�e F�Psf �aik u� Y5'l5� �eS-97� 67/7 <br />Property Owner t.faa Aadress Gtp State2ip Pnone <br />Tenant Name Qf Ihis is for a commercial business) <br />�iLiZ G�n�+f�aS.LCG 17f32 �-fvdG�iu�Nr,LGG�e. f/p��-��c✓�t��.,A 98�5� �/�5-676-7�5 <br />COntractor n1aJ Atltlmss Cdy :tatelLp Phone <br />Sm zcoc � �se P�2 <br />WA State Contractor License �umber (reqwred) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side 5ewer - Ne�v instaliation <br />�3( Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Instail Water Met?r <br />FEVI$[D 11/titiOH <br />v�v 89i <br />City of Everett �uslness License Number (required� <br />FEE ^I� <br />��},� W <br />"�lJ , <br />PERMff� <br />u�'�1�-0� <br />